胃神经内分泌癌的临床病理特征及预后分析

Clinico-pathological characteristics and prognosis of 40 patients with gastric neuroendocrine carcinoma

目的 探讨胃神经内分泌癌（gastric neuroendocrine carcinoma,G-NEC）的临床病理表现、诊断要点、治疗方法及预后.方法 对上海交通大学医学院附属仁济医院2003年1月至2013年8月收治的40例G-NEC患者的临床病理资料进行回顾性分析.依照2010年WHO消化系统肿瘤分类标准和2006年欧洲神经内分泌肿瘤协会胃肠胰神经内分泌肿瘤的分级建议,对肿瘤进行命名、分级、分期.采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行单因素分析,COX比例风险回归模型进行多因素分析.结果 本组40例G-NEC中男29例（72％）,女11例（28％）,中位年龄为61岁.肿瘤位于贲门20例,胃窦11例,胃体9例.肿瘤直经1-20 cm.40例G-NEC均为G3.40例G-NEC均获得随访,患者中位生存时间为12个月,1年生存率为82％.病理学检查：高倍镜下细胞呈腺样或者玫瑰花样.免疫组化检查显示40例G-NEC中Syn阳性36例,CgA阳性15例,其中Syn和CgA均阳性11例.单因素分析结果显示：性别、Ki-67计数、淋巴结转移是影响G-NEC患者预后的因素（χ^2=5.673、8.612、0.559,均P＜0.05）;多因素分析结果显示：性别是影响G-NEC患者预后的独立因素（P＜0.05）.结论 G-NEC的临床表现无特异性,其确诊依赖于病理学及免疫组织化学检查,Syn和CgA是诊断G-NEC的重要标志物.男性G-NEC预后较女性差,Ki-67计数高和淋巴结转移率高的患者预后差.

Objective To analyze the clinico-pathological characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma（G-NEC）.Methods Clinical data of 40 cases of G-NEC form January 2003 to August 2013 at Ren Ji Hospital of Shanghai Jiaotong University were analyzed.Tumors were classified into different grades and stages according to the 2010 WHO classification and the 2006 European neuroendocrine tumor society （ENETS）.Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by the COX proportional hazards model.Results Among the 40 G-NECs patients,29 were male（72%） and 11 were female（28%）,with an median age of 61 years.Tumors located in the gastric cardia in 20 cases,in the gastric antrum in 11 cases and in the gastric body in 9 cases.Tumor ranged from 1 cm-20 cm.All patients were G-NEC （G3）.Follow-up rate was 100% （40/40）.The median overall survival rate was 12 months,and one-year survival rate was 82%.Immunohistochemically G-NEC cells were positive for CgA and Syn in 11 cases.Gender （χ^2 =5.673,P 〈 0.05）,Ki-67 index （χ^2 =8.612,P 〈 0.05）,and lymphnode involvement （χ^2 =0.559,P 〈 0.05） were prognostic factors of G-NEC patients.Conclusions The symptoms of G-NEC are nonspecific.Its diagnosis relies on pathological examination and immunohistochemistry.Syn and CgA are the most important markers.Female gender,lower Ki-67 index and lower lymph node metastasis predict a survival advantage.